N Madlala-Routledge: Health Dept Budget Vote debate, NCOP

6 June 2006

Madam Speaker,
Honourable members,
Health workers,
Invited guests:

I rise to support the budget vote of the Minister of Health. I do so
believing sincerely that as South Africans coming as we do from all walks of
life we can find common ground on health issues. This is the crucial basis from
which we should all be moving. As a young democracy we have proved to ourselves
and shown the world that we are capable of putting our differences aside in the
interest of the broader goal of peace and progress in our beloved country. In
making this appeal, I want to remind honourable members and fellow South
Africans of what we said in the preamble of our Constitution and I quote:

“United in our diversity we therefore, through our freely elected
representatives, adopt this Constitution as the supreme law of the Republic so
as to:
* heal the divisions of the past and establish a society based on democratic
values, social justice and fundamental human right
* lay the foundation for a democratic and open society in which government is
based on the will of the people and every citizen is equally protected by
law
* improve the quality of life of all citizens and free the potential of each
person
* build a united and democratic South Africa able to take its rightful place as
a sovereign state in the family of nations.

May God protect our people. Morena boloka setjhaba sa heso.”

We adopted our Constitution 10 years ago and as we debate this Budget Vote
on Health, may we be reminded of the inspiration we felt, having agreed to heal
our divided past and to move forward as a united and prosperous people. I want
to add, to move forward also as a healthy nation. To achieve this we need to
build a strong and united front, led and guided by all leaders in this country.
That clear and united voice will rally and galvanise our people into action,
acting together in the interest of the health of all.

The goal of providing health to all is a concern for everyone and is more
important than individual and party political differences. It requires that we
acknowledge where there are differences and to bring the creative power in all
of us to throw light and evidence of science and joint problem solving on these
differences so that we can reach consensus on how to provide the optimal
healthcare within the limited resources.

As outlined in the Minister’s speech we have made great strides in laying
the foundation for the delivery of quality health services to all in our
country. Some of these achievements include developing policies that are
specifically aimed at addressing health disparities and implementing an
integrated health system, focusing on preventive healthcare. We have passed new
laws to transform and integrate the health system. We have built up the
district health system as the basic unit from which all South Africans can
access their basic health needs. We have developed systems for multi sectoral
collaboration and public-private partnerships (PPP). We have developed
structures for public consultation and participation.

The National Health Act establishes clinic committees, health forums at ward
level, hospital boards, and district, provincial and national consultative
forums (NCF). These structures are created for people’s participation on health
matters and are derived directly from our Supreme Law, our Constitution as a
means for building consensus on these critical issues. We do not want health to
be politicised at the local clinic level.

In addressing the house I wish to report on progress and challenges in the
following areas which the Minister of Health has delegated to me. These
are:

* implementation of the Mental Health Act
* chronic diseases, disabilities and geriatrics
* health technology
* oral health
* the effective transfer of mortuaries and forensic services.

Honourable members, our Department has been hard at work preparing the
ground for the provision of a full basket of healthcare services at all levels.
We are committed to providing a minimum defined basic package of care that is
available to all patients in both the public and private sectors regardless of
the ability to pay. This package will provide a healthcare safety net for all
but will not preclude the purchase of larger baskets of health services by
persons who can afford it. In the context of limited resources, the challenge
inevitably involves rationing choices and reaching consensus around the content
and delivery mechanisms for this package.

Our strategic plan for 2006/07 has prioritised plans to integrate mental
health as part of the minimum basket of cares at primary healthcare level and
as part of our general health services.

Working with our Health MECs we are ensuring that Mental Health Review
Boards are appointed in all nine provinces. We are also finalising the referral
pathways and compiling the list of facilities that will conduct 72-hour
assessments.

Our inability to move with speed in implementing the Mental Health Act has
to do with issues of shortage of mental health professionals and problems of
systems and infrastructure. We are addressing these problems and have included
our mental health personnel requirements in the Human Resource Plan for
Health.

As part of promoting health and wellness we are transforming mindsets so
that people adopt health seeking behaviour. We are providing opportunities for
regular health check ups at our facilities and through mobile units. We
encourage everybody to use these facilities to check their health even when
they feel well. Many illnesses are silent killers, showing no symptoms in the
early stages where they can be most easily and effectively treated. Early
diagnosis and disease management are crucial.

As honourable members know, mental illness has a stigma in our society and
people tend not to seek help until it is too late. We are going to step up our
awareness raising efforts on mental health. I wish to raise the issue of mental
health in the context of post-conflict reconstruction. Post-conflict societies
are characterised by high levels of post-traumatic stress disorder not only for
the ex-combatants and soldiers but society as a whole. Civilians and vulnerable
components of society are often subjected to different forms of violence,
including dislocation, rape and child soldiers. Being developed by the Council
for Scientific and Industrial Research (CSIR) the doctrine on developmental
peace missions for the African Union (AU) will include the provision of mental
health as part of post conflict reconstruction.

We are assessing all our public hospitals for accessibility to people with
disabilities. We are strengthening policy on free healthcare for people with
disabilities and are facilitating the implementation of International
Classification of Functioning, Disability and Health (ICF). We are developing a
strategy on orientation and mobility services for the blind. The guideline on
the implementation of the National Rehabilitation Policy (NRP) has been
finalised and the revision of the price list for orthotic prosthetic devices
has been completed.

We are supporting the health needs of the elderly. Our policy is to keep the
elderly in the community with their families as long as possible. In
partnership with the Department of Social Development, we are implementing the
integrated nutrition programme for vulnerable children alongside the luncheon
clubs for the elderly in order to allow for interaction between our seniors and
our children. This way we hope to tap on the wisdom of our senior citizens in
moulding the characters of our young people. Bathi ngesiZulu libunjwa liseva,
kanti umthente uhlaba usamila.

We are involved in developing survey indicators for the World Health
Organisation (WHO) Study on Ageing (SAGE). The study seeks to create a
multi-country platform for data collection which results in a reliable source
of health information about adult populations aged 50 years and older. The SAGE
will build on innovative methodologies and data collection platform created by
the World Health Survey (WHS) programme to improve the quality, comparability
and amount of data at national and sub-national levels. This financial year we
will implement a long term home-administered oxygen programme in all provinces,
as well as facilitating the establishment of stroke units in provinces to
ensure that they are fully equipped to deal with this disease.

Turning to health technology, first, I want to add my voice to those who
have expressed sincere condolences to the families of the babies that died at
Cecilia Makiwane a few weeks ago. As stated in the statement issued by the
Department of Health this sad incident is regrettable. We are correcting the
situation by ensuring that we have back up generators in working order at our
hospitals.

The death of these babies is a sad reminder to the Department to speed up
the implementation of quality control and standards in the procurement and
management of medical equipment. I am happy to report that the Department will
be publishing health technology regulations by the end of July 2006, which will
provide for the licensing and registration of medical equipment and service
providers.

The regulations will provide for the selection of appropriate technology to
ensure equity in distribution, affordability and sustainability as well as
cover the competencies needed for safe and proper utilisation of equipment. We
are simplifying procurement processes, addressing personnel, equipment shortage
and issues of risk management and infection control. We have set aside R5
million to conduct audits of medical equipment at level two hospitals in all
nine provinces. I thank the Swedish government for funding the training of
health technology assessment personnel and the Japanese International
Co-operation Agency for co-operating with the Department in hosting workshops
on medical equipment maintenance at public hospitals.

Together with the South African Qualifications Authority (SAQA) the Council
of Health Engineers is helping us fine tune issues of accreditation and
registration of health engineers and technicians. Developing the critical
skills needed in health technology requires that we appeal to our youth to take
up training as health engineers and technicians.

Clinical and health engineers are in huge demand and are snapped up by the
private health sector as soon as we train them. We therefore must agree to
train more for our own needs and that of the private health sector. I am
certain that the Joint Initiative on Priority Skills (JIPSA), under the
leadership of the Deputy President will be taking this into account. This is an
opportunity for youth to take up these training opportunities and be assured of
employment on graduating.

Madam Speaker, we have made progress in the promotion of oral health. Our
policy has shifted from curative, hospital and urban-based oral healthcare. We
are integrating oral healthcare as part of our healthy lifestyles campaign. We
have integrated it in the Road to Health Chart for our babies. As that first
tooth emerges we want to make sure that it is strong and healthy.

During the month of June discussions will be held with our Dental Training
Centres on aspects of the Human Resource Plan (HRP) dealing with oral health.
This financial year we are championing the Regulations on Fluoridating Water
Supplies. All stakeholders will be consulted on these regulations including in
particular the Department of Water Affairs and Forestry and provincial and
local government, South African Association of Water Utilities, South African
Local Government Association (SALGA), legal units and academic
institutions.

We are finalising a national oral health promotion framework as well as a
manual on oral health for community and home-based care that will guide
provinces. I found it most heartening when I saw the enthusiasm of the schools
in Gauteng that are on our oral healthcare programme for schools. During my
visit to two schools, Westonaria and Munzieville, I found that through this
programme the schools are assisting we identify not only oral health problems
but also other health ailments. Congratulations Gauteng!

Visits are planned to other provinces to assess compliance with national
oral health norms and standards, explain oral health services to districts and
hospitals managers and make recommendations for improvements. We have set aside
R2,322 million to ensure an efficient oral health service for the 2006/07
financial years.

I am saddened, Madam Speaker, by reports of health practitioners who are
defrauding taxpayers by falsifying medical claims to enrich themselves. More
than 40 dentists, dental technicians and doctors in Durban could face criminal
charges for contravening the Dental Technicians Act 19 of 1979 as amended. I
would like to make a call to all South Africans to expose these unscrupulous
health practitioners.

I wish to remind members that August is Oral Healthcare Month. Last year I
visited the Phelophepha Health train during Oral Health Month. I saw first hand
the dedication of the Phelophepha team to taking healthcare to all, especially
the most remote and isolated parts of our country. I wish to thank Transnet for
donating a second train to Phelophepha so that they can do more. I thank
Phelophepha for their contribution in helping us bring our vision universal
access to healthcare that much closer.

Phelophepha works with dental students and oral hygienists who live on the
train and volunteer their services. June is youth development month. The
Department of Health community service programme is working and provides a
template for the rest of the civil service. Young South Africans are eagerly
contributing to healthcare delivery, especially to the underserved communities.
Through community service, we are providing the environment and supporting the
youth to serve our people.

Replicating this model in other departments could see our youth going from
village to village teaching our people how to read and write and helping them
access government programmes. I think how wonderful it would be to have a young
accountant, lawyer, engineer, social worker, and teacher doing community
service in my constituency in Vulamehlo in Ugu District. They would be very
warmly welcomed and collectively would be a valuable asset working with the
municipality.

To illustrate the enthusiasm of our youth, I wish to read a letter I
received this year from Dr Kerry Anne Sherwood who is doing community service
in Mtunzini. She wrote, “Dear Mrs Madlala-Routledge it has come to my attention
that you played a pivotal role in ensuring my community service post at
Ngwelezane Hospital. I would like to thank you for the opportunity to work in a
rural environment. I have found it extremely worthwhile and can only hope that
I have been of good service to this community in return. I have gained a lot of
experience especially at the maternity hospital, for this I am so grateful as
obstetrics and gynaecology is my passion. Enkosi kakhulu, yours sincerely Dr
Kerry Anne Sherwood.” Health is playing a valuable part in nation building and
I wish to add my thanks to all the young medical personnel doing community
service.

In April this year the Minister of Health launched the transfer of Medico
legal services from the police to provincial health departments, as per Cabinet
decision. A review of the services found that there was fragmentation and lack
of co-ordination. The transfer is aimed at ensuring separation and autonomy, as
well as offering comprehensive services which will be overseen by a national
directorate. This illustrates our commitment to providing quality healthcare
from cradle to grave and restoring the dignity of our people.

An emergency maintenance and upgrading project is in progress including the
purchasing of urgently required equipment and vehicles with a budget of R72
million. More than R1,5 billion has been allocated for the implementation of a
modernisation plan, which includes the refurbishment of some of the selected
mortuaries and the building of new ones. A total of 1 349 non-medical vacancies
have been advertised in all provinces and some appointments have already been
made. As part of the skill retention strategy, an agreement was reached with
South African Police Service (SAPS) to give the serving police officers in the
mortuaries first preference in the filling of posts.

Medico legal services are a critical component of the criminal justice
system. I want to acknowledge the sterling work being done by the Gender and
Justice Unit at Groote Schuur Hospital under the leadership of Professor Lorna
Martin. The unit is helping us monitor the implementation of the Domestic
Violence Act and trains health personnel in the diagnosis of gender-based
violence and in counselling rape survivors. I also wish to thank Retail Edgars
Consolidated Sores (EDCON) for making a generous donation to the unit. This is
an example of the private-public partnership (PPP) that we are trying to
build.

It is crucial that our forensic investigations meet internationally accepted
norms and are performed in an accountable and transparent manner. A memorandum
of understanding (MoU) has been signed between the departments of Health,
Public Works and Safety and Security to ensure a smooth transfer. In this
financial year, we aim to upgrade all mortuaries to minimum standards in order
to comply with the requirements of the OSH Act and address the backlog of
specimens for blood alcohol and toxicological analyses. We are also looking at
establishing Forensic Pathology Officer learnerships with career pathing
opportunities and obtaining South African National Accreditation System (SANAS)
accreditation for the blood alcohol sections of the laboratories.

We are also looking at improving the provision of palliative care. This is
care for terminally ill patients. I visited the family medicine branch of the
medical school at the University of Cape Town (UCT) where a multi-disciplinary
diploma course is being offered on palliative care and pain management. Our
medical schools are committed to providing for the needs of our country. I had
the privilege to open the International Conference on Palliative Care hosted by
UCT at the end of 2005.

Madam Speaker, I wish to pay tribute to medicine and science in the fight
against disease. Through progress in medicine we are living longer. We are
finding ways to prevent and treat cancer, what was once dubbed the dreaded
“C.”

A vaccine has been developed to fight cervical cancer and this development
promises to make a huge impact in the campaign against cervical cancer and
HIV/AIDS. Currently we are aware of the following pilot research projects
ongoing within our universities:

1. Single visit approach – by Professor Lindeni in the Western Cape;
2. Screen and treat to prevent cervical cancer in low resource settings started
on 2000 – three years follow up until December 2005 analysis completed by UCT
(Professor Lyneatte Dean);
3. Human Papilloma Virus (HPV) prevalence and type in women 18 – 34 years by
UCT (Professor Lyneatte Dean);
4. Management of abnormal cytology in HIV/AIDS positive women by University of
Bloemfontein (Professor Cronjé).

Efforts are being made by the government to secure funds to support our
research from local and international organisations.

The international conference on microbicides held in Cape Town in April this
year was happening for the first time on African soil, this conference heard
about the advances in developing microbicides. This holds much promise for
assisting in fight against HIV/AIDS. Microbicides offer women a tool they can
control directly with or without the knowledge and permission of their
partners. I congratulate the Medical Research Council (MRC) and the
Reproductive Health Research Unit at Wits, as well as government for hosting
this conference. I thank the civil society for their participation and
Ministers Mangena and Tshabalala-Msimang, Ministers of Science and Technology
and Health, respectively, for their support at this landmark conference.

The Department of Science and Technology sponsored two awards at this
conference for the best and emerging researchers. This is an important
contribution to building our research skills base. I wish to stress the
importance of evidence based research as opposed to anecdotal and walking
evidence. South Africa is playing its role in contributing to medical and
scientific research. I am proud of our scientists. In February this year I
attended a conference organised by the Academy of Science of South Africa
(ASSAf). Established by an Act of Parliament, the academy is taking up a place
in South Africa’s science system as an independent, merit-based “activist” body
committed to assisting the nation to find science based solutions for its
problems and to create science based opportunities for growth and
prosperity.

The preamble to the Constitution of ASSAf articulates the vision of the
academy. It says, “The function of science is to create in a disciplined and
systematic way, a continuum of coherent, rational and universally valid insight
into observable reality in all its various facets. Scientific thinking and
knowledge are fundamental to the best work done in the applied natural sciences
and in technology and this applies too much of the human and social
sciences.

An academy which effectively harnesses the minds and energies of the most
able practitioners harnesses the minds and energies of the most able
practitioners of scientific thought reflects as almost nothing else does the
strong bonds between scientific disciplines and the unique character of the
scientific contributions to the lives of all citizens.

The Academy of Science for South Africa is constituted to ensure that
leading scientists acting in concert and across all disciplines, can promote
the advancement of science and technology, can provide effective advice and can
facilitate appropriate action in relation to the collective needs, threats,
opportunities and challenges of all South Africans.”

Madam Speaker, honourable members, I wish to thank the Minister of Health,
the Health MECs, our Director-General, Deputy Directors-General and all heads
of departments in the nine provinces as well as my own staff and more
importantly our health personnel who serve us when we need them most, when we
are sick and not able to take care of ourselves. I wish to assure our people
that working together in the spirit of co-operation and communicating
effectively, affirming each other’s achievements and correcting and supporting
one another with compassion when we fail, we can achieve the goal of
comprehensive and quality health to all South Africans envisioned in our
Constitution.

Thanks!

Issued by: Department of Health
6 June 2006